Individual
MRS. STACIE NICOLE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 444-6350
Mailing address
31199 WILSON MYRTLE DR, MILLSBORO, DE 19966-4638
(302) 381-9354
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
J2-0000766
DE
Other
Enumeration date
02/26/2013
Last updated
02/26/2013
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